The August EMS Roundup

It’s midnight in San Fransisco and I am waiting here for Jesus on my knees.

In August and everything after, I want someone else to bleed for me.

- Counting Crows, August and Everything After

A busy month indeed at The EMT Spot. This month I experimented with quality over quantity and I hope you found enough good stuff to stimulate your noggin. We started with another installment of the ultimate guide to EMT vital signs. This month we looked at respiration. Then I took another run at the controversial phrase, “Patient’s define their emergencies.” After that we talked about doctors watching EMS care on cameras and we wrapped it all up with the question, “Is there such a thing as too much information?“

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Doctors Watching EMS Care on Cameras?

I’m all for trying new things. I love to see the new gadgets and ideas that find their way into the prehospital arena. One of my favorite past-times is telling stories about people trying new, cool things. Having said that, some things just set off my skeptic meter. (Some people use a less PC term for “skeptic meter.)

For some reason this next story set my skeptic meter needle into the red. I’d like to know what you think.

Florida tax-payers are funding a $100,000 camera system for various key-west EMS providers that will allow doctors and trauma surgeons to view the prehospital environment remotely from the hospital. Apparently these cameras will be worn by various EMS personnel and be installed in the local transport vehicles to give the hospital a real time view of accident scenes and patient care.

The big selling point being pushed is that, when doctors are allowed to look at the patients on scene, they’ll be better prepared to receive them at the hospital. This visual benefit is supposed to be great enough to justify the tremendous financial, logistical and technological burden of installing, carrying and maintaining all these cameras. I’m not so sure.

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The Ultimate Guide to EMT Vital Signs

Part 4: Respiration

The respiratory vital sign rounds out our “big three” vital signs. (Pulse and blood pressure being the other two.) It is, quite possibly, the most misunderstood and overlooked of the big three vitals.

Two big problems we encounter when factoring in the respiratory component of the vital signs are:

1) We’re comfortable fibbing about the true respiratory rate. More so than pulse or blood pressure, respirations encourage us to violate the first rule of vital signs. Especially when the patient is in no apparent distress. We look at the patient, we make up their respiratory rate and, quite often, we’re wrong.

2) We fail to recognize the relationship between rate and volume. In EMT school we are rarely asked about the respiratory volume. We perform our scenarios. We count a rate of respiration. We report it. The scenario moves on. In the process we forget that respiratory rate is only half of the breathing equation. Without volume, the rate means very little to us.

With those two common errors in mind, let’s talk about obtaining an accurate respiratory rate and then let’s talk about truly assessing the quality of the patients respirations. Consider this your quick guide to respiration assessment mastery.

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The July EMS Roundup

“That beautiful season the summer!

Filled was the air with a dreamy and magical light;

and the landscape

Lay as if new created in all the freshness of childhood.”

- Henry Wadsworth Longfellow

Here in Colorado, July came with all the freshness of weddings, heat and afternoon thunderstorms. I took a short break to go to California and play best man at the wedding of a great friend. And then it was back in the EMS blogging saddle. We started with a discussion about eight tragic EMS behavior flaws to avoid and then I gave you 207 reasons to stay current on you continuing education. I explained why litter begets litter and then asked you to finish the sentence, “Behind every great EMT…” We ended off with a lively discussion about fire based EMS vs. private EMS which is still raging on. Bring the storm!

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Fire Based EMS vs. Private EMS

“In Germany they first came for the communists, and I didn’t speak up because I wasn’t a communist. Then they came for the Jews, and I didn’t speak up because I wasn’t a Jew. Then they came for the trade unionists, and I didn’t speak up because I wasn’t a trade unionist. Then they came for the Catholics, and I didn’t speak up because I was a Protestant. Then they came for me – and by that time no one was left to speak up.”

- Rev. Martin Niemoller

Yesterday an Action Care ambulance covered my station while I was at a training. Action Care is the local private ambulance service. I know, the name always seemed a little silly to me. If a super hero ever created an ambulance service, he would most certainly call it Action Care. I joke about the name, but they’re the real deal. If you’re going to work as a private service EMT, you could do worse than Action Care. And if that doesn’t work out, there’s always the medical billing and coding field.

I’m glad we have Action Care. They help cover our district when we are low on resources. They are always professional and polite on scene. They give good care.

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Litter Begets Litter

Here’s a little bit of applied psychology for you. In 1990 some researchers tried an experiment. People were handed a piece of paper in a local park while they were walking down a path. (A public service announcement to be exact.) After they walked past the leaflet handing researcher they then walked through an area where, unbeknown to them, the number of pieces of litter on the ground was being meticulously controlled.

You may be able to guess the results. If there were no pieces of litter on the ground, or only one piece, the subjects were unlikely to throw the unwanted piece of paper on the ground. After that, the likelihood of the person discarding the paper on the ground was exactly proportional to the number of pieces of paper already on the ground. The more litter already present on the ground, the more likely that the next person would also throw their piece of paper on the ground. It’s the law of social conformity.

Litter begets litter.

This isn’t new news. The 1990 research (Cialdini, Reno and Kalgren) was a repeat of similar research done in 1973 (Finnie), 1977 (Geller, Witmer and Tuso) and 1978 (Krause, Freedmen and Whitcup.)

How does this apply to you?

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The June EMS Roundup

“In June, as many as a dozen species may burst their buds on a single day. No man can heed all of these anniversaries; no man can ignore all of them.”

-Aldo Leopold

So many anniversaries. So many happenings in the EMS world. Regardless of how many of them you attempted to heed, you were bound to miss a few. Here’s to the stuff you may have inadvertently ignored.

I started the month with a webinar on how to pass the national registry cognitive exam and quickly moved on to the name the chronicles contest and part three of the very popular ultimate guide to EMT vital signs. I asked you two telling questions with “Where do you put the fear?” and “Are you an EMS nonconformist?” before asking you to consider what will happen on the day that your career clock strikes midnight. Then we talked about what really motivates us and wrapped up with ten reasons why I work in EMS.

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Ten Reasons I Work In EMS

I was recently asked by a reader to explain why I work in EMS. It’s a compelling question. Sometimes, browsing through the blogsphere, you can feel like you’re inundated with content explaining why you shouldn’t work in EMS.

It’s strange. In a line of work as interesting, diverse and unique as ours, you’d think our blogs would read like a fan page for a band called EMS, but that’s just not the case. How to survive in EMS, how to scrape by and how to “fix” EMS seem to be the relevant topics of the day. I thought this readers question was a great opportunity to go on the record and say that there are a lot of good reasons to work in EMS. Here are ten.

It’s different.

I’ve learned that I don’t do well with routine. I couldn’t spend my work life in a cubicle. I’d rather chew tinfoil than show up each day and do the same thing. EMS is infinitely variable. Just when you think you’ve seen it all someone will pick up the phone, dial 911 and prove you wrong.

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What Motivates Us Really?

The Surprising Truth About Personal Motivation

For years as an EMS supervisor I sat in operations meetings discussing the timeless business question, “How do we motivate people to be high performers?” Since most everyone in the room was a current or former field paramedic, you’d think we’d have an edge in answering the question. We didn’t.

It’s worth considering while your sitting around with your partner, hashing out the latest management blunders and explaining how you’d fix everything. If it was you sitting in the agonizingly long staff meeting throwing around ideas, chances are, you wouldn’t do much better.

I do know that the one opportunity I had to work on a true high-performance EMS team, these were the basic ingredients.

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What Is An EMS Non-Conformist?

An Excerpt from The Non-Conformists Guide To EMS Success

The allure of conformity is powerful for all it offers. On the other side of the conformity dance floor is security, approval, and all the benefits of eventual success. Why wouldn’t we waltz? Doesn’t everybody?

Perhaps that desire within us to do something that matters can be fulfilled after we’ve gained the promotions, the love and admiration of our peers, and the power of authority.Then we can start being an advocate for the patient. Then we can start taking good care of the folks who call 911.

We can bone up on our skills, attend the conference, and develop the competencies we were putting off until we got the official nod. We’ll work hard to improve basic proficiencies, overhaul the broken training and orientation systems, and advocate for safer work conditions.

This is all a broken promise the minute we make it. Once we’ve achieved some degree of success by walking the path of conformity the expectations will only continue to grow.

Your leaders, whoever they are, have even less power to step outside the boundaries than you. If there is pressure on you to conform, you can bet there’s twice as much pressure on the poor guy or gal above you. Poor saps.

Non-conformity is stepping back from the speed and thoughtlessness that we tend to operate under. We manage emergencies. Most of our leaders have grown out of this industry that specializes in the fast fix approach. In our business, speed is king, and time is the devil. This creates an environment that doesn’t value thoughtfulness or introspection.

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